51321 Econ Risk Attach A-1_Survey_rev

Understanding Economic Risk for Families with Low Incomes: Economic Security, Program Benefits, and Decisions About Work

51321 Econ Risk Attach A-1_Survey_rev

OMB: 0990-0487

Document [docx]

Download: docx | pdf

Form Approved

OMB No. 0990-

Exp. Date XX/XX/20XX

Client	Mathematica
Project Name	Beneficiaries Pilot
Project Number	9312
Survey length (median)	15-minute survey
Population	Below 130% FPL
Main	N=200
MODE	Web only
Language	English
Sample Source	Opt-in
Incentive	5,000
Survey description	Finance

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0379. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, to review and complete the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

Standard demographic preloads:

Var Name	Include on Preload Testing-page?	Var Type	Var length	Variable Label
S_AGE	Y	Numeric	5	Age
S_GENDER	Y	String	8	Gender
S_RACETH	Y	Numeric	8	Race/ethnicity
S_EDUC	N	Numeric	6	Education
S_EDUC5	Y	Numeric	4	5-level education
S_MARITAL	Y	Numeric	9	Marital Status
S_EMPLOY	Y	Numeric	8	Current employment status
S_INCOME	N	Numeric	8	Household income
S_HHINC_4	N	Numeric	4	4-level income
S_HHINC_9	N	Numeric	4	9-level income
S_STATE	Y	String	7	State
S_METRO	N	Numeric	7	Metropolitan area flag
S_INTERNET	N	Numeric	10	Household internet access
S_HOUSING	N	Numeric	9	Home ownership
S_HOME_TYPE	N	Numeric	11	Building type of panelist’s residence
S_PHONESERVC	N	Numeric	11	Telephone service for the household
S_HHSIZE	N	Numeric	8	Household size (including children)
S_HH01	N	Numeric	6	Number of HH members age 0-1
S_HH25	N	Numeric	6	Number of HH members age 2-5
S_HH612	N	Numeric	7	Number of HH members age 6-12
S_HH1317	N	Numeric	8	Number of HH members age 13-17
S_HH18OV	N	Numeric	8	Number of HH members age 18+
S_file_date	N	Date	11
S_GENFRACE	N	Numeric	8	GenF custom race

These populated as a pre-load when the panelists get sampled into the survey

Standard sample preloads

Variable Name	Include on Preload Testing-only page?	Variable Type	Variable Label
Username	N	Numeric	Analogous to Member_PIN
P_Batch	N	Numeric	Batch Number (if only one assignment, then everyone will be 1)
Dialmode	N	Numeric	CATI Dialmode (predictive, preview, etc)
P_LCS	N	Numeric	Life cycle stage, 0=released but not touched
Y_FCELLP	N	String
Surveylength	N	Numeric	Estimated length of survey
Incentwcomma	N	String	Study specific
P_Hold01	N	Numeric	Prevents dialing cases without phone numbers
PANEL_TYPE	Y	Numeric	1 AmeriSpeak 2 Next Generation 3 GenF Extended (not in use) 4 AmeriSpeak Teen Panel 11 UTellUs converted 20 Lucid 21 SSI 50 Household 13-17 51 Household < 13 52 Household Adult

Custom survey-specific preloads

Variable Name	Program in VCC?	Include on Preload Testing-only page?	Variable Type	Variable Label
P_VIGNETTE	Yes	Yes	Numeric	1 vignette 1,2,3,4,5 2 vignette 2,3,4,5,6 3 vignette 3,4,5,6,1 4 vignette 4,5,6,1,2 5 vignette 5,6,1,2,3 6 vignette 6,1,2,3,4
P_CONDITION	Yes	Yes	Numeric	1 Condition 1 2 Condition 2 3 Condition 3 4 Condition 4 5 Condition 5 6 Condition 6 7 Condition 7 8 Condition 8 9 Condition 9 10 Condition 10 11 Condition 11 12 Condition 12 13 Condition 13 14 Condition 14
RID	YES	YES	STRING	LUCID ID

This survey will use the following RND_xx variables:

Note, these are randomized in the script (NOT preloads)

RND_xx	Associated survey Qs
RND_00
RND_01
RND_02
RND_03
RND_04
RND_05
RND_06

[START OF SURVEY]

CREATE DATA-ONLY VARIABLE: QUAL

1=Qualified Complete

2=Not Qualified

3=In progress

AT START OF SURVEY COMPUTE QUAL=3 “IN PROGRESS”

CREATE MODE_START

1=CATI

2=CAWI

(Project name) Draft

Date: (Quex start date)

IF PANEL_TYPE<20 SURVEY LOGO IS AMERISPEAK LOGO (STANDARD SURVEY HEADER)

IF PANEL_TYPE>=20, SURVEY LOGO IS NORC IMAGE

A0.

Thank you for agreeing to participate in our survey! This survey is about finance. Your answers are confidential.

This survey is conducted by the U.S. Department of Health and Human Services (HHS). This survey is being collected by HHS under OMB 0990-0281. This survey will take approximately 20 minutes to complete. Your participation is voluntary and you have the right to stop at any time.

We will ask you about your educational and employment history and collect some demographic data. We will also describe some different choices that people are trying to make and ask for your opinion about what you think they should do.

Please take your time as you answer these questions. The information you provide will contribute to valuable research at HHS, and will help the federal government make policy decisions about how to serve people like you.

This survey is being run by AmeriSpeak. The survey is hosted on a secure server. By proceeding, you give your consent to participate in this survey.

Please use the "Continue" button to navigate between the questions within the questionnaire. Do not use your browser buttons.

[DROPDOWN]

[PROMPT]

A1.

What state do you currently live in?

[DROPDOWN LIST OF STATES]

Name	Alpha code	Numeric code
Alabama	AL	1
Alaska	AK	2
American Samoa	AS	60
Arizona	AZ	4
Arkansas	AR	5
Baker Island	BI	81
California	CA	6
Colorado	CO	8
Connecticut	CT	9
Delaware	DE	10
District of Columbia	DC	11
Florida	FL	12
Federated States of Micronesia	FM	64
Georgia	GA	13
Guam	GU	66
Hawaii	HI	15
Howland Island	HI	84
Idaho	ID	16
Illinois	IL	17
Indiana	IN	18
Iowa	IA	19
Jarvis Island	JI	86
Johnston Atoll	JA	67
Kansas	KS	20
Kentucky	KY	21
Kingman Reef	KR	89
Louisiana	LA	22
Maine	ME	23
Marshall Islands	MH	68
Maryland	MD	24
Massachusetts	MA	25
Michigan	MI	26
Midway Islands	MI	71
Minnesota	MN	27
Mississippi	MS	28
Missouri	MO	29
Montana	MT	30
Navassa Island	NI	76
Nebraska	NE	31
Nevada	NV	32
New Hampshire	NH	33
New Jersey	NJ	34
New Mexico	NM	35
New York	NY	36
North Carolina	NC	37
North Dakota	ND	38
Northern Mariana Islands	MP	69
Ohio	OH	39
Oklahoma	OK	40
Oregon	OR	41
Palau	PW	70
Palmyra Atoll	PA	95
Pennsylvania	PA	42
Puerto Rico	PR	72
Rhode Island	RI	44
South Carolina	SC	45
South Dakota	SD	46
Tennessee	TN	47
Texas	TX	48
U.S. Minor Outlying Islands	UM	74
Utah	UT	49
Vermont	VT	50
Virginia	VA	51
Virgin Islands of the U.S.	VI	78
Wake Island	WI	79
Washington	WA	53
West Virginia	WV	54
Wisconsin	WI	55
Wyoming	WY	56

PN: TERMINATE AND SEND TO TERMSORR IF A1 > 56

[NUMBOX]

[PROMPT IF SKIPPED ON WEB: “Please enter in your age. We require this information for your responses to be counted”]

[PROMPT IF A2 <18 OR A2 > 65: “You said you are [A2] years old. Please confirm that this is correct before continuing”

A2.

What is your age?

[0-100] years old

[IF A2<18 OR A2 > 65, TERMINATE AND SET QUAL=2]

[SP]

[PROMPT: “Please tell us your gender. We require this information for your responses to be counted”]

A3.

How do you currently describe yourself?

RESPONSE OPTIONS:

Male
Female
Transgender
Do not identify as male, female or transgender: [TEXTBOX]

[SP]

[PROMPT]

A4.

Are you now married, unmarried (but live with your partner), widowed, divorced, separated, or have you never been married?

RESPONSE OPTIONS:

Married
Unmarried but live with your partner
Widowed
Divorced or separated
Never married

[SP]

[PROMPT]

[custom prompt: “Information about any possible Hispanic ethnicity is very important. We greatly appreciate your response to this question.”]

A5.

Are you of Hispanic, Latino, or Spanish origin?

RESPONSE OPTIONS:

No, not of Hispanic, Latino, or Spanish origin
Yes, Mexican, Mexican American, or Chicano
Yes, Cuban
Yes, another Hispanic, Latino, or Spanish origin

[MP]

[PROMPT]

A6.

What is your race? Are you:

[SPACE]

<unbold> Select all that apply. <remove unbold>

RESPONSE OPTIONS:

Alaska Native or American Indian
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Some other race (SPECIFY): [TEXTBOX]

[SP]

[PROMPT]

A7.

What is the highest level of school you have completed?

RESPONSE OPTIONS:

Never attended school
Did not complete high school or GED
High school degree, high school certificate of completion or GED
Some college or vocational courses
2-year or 3-year college degree (Associate’s degree) or vocational degree
4-year college degree (Bachelor’s degree)
Graduate or professional degree (e.g., MA, MBA, Ph.D., J.D., M.D.)

NUMBOX

[PROMPT IF A8 > 9 AND NOT SKIPPED ON WEB: You entered [A8] adults 18 years of age or older live in your household, including yourself. Please review your response and continue.]

[FORCE RESPONSE]

A8.

How many adults 18 years of age or older live in your household, including yourself?

[SPACE]

This includes all adults who usually live there, even if they are temporarily away on business, vacation, in a hospital, away at school or on military duty.

[NUMBOX; 1-99] Number of Adults

NUMBOX

[PROMPT IF A8A > 9 AND NOT SKIPPED ON WEB: You entered [A8A] children under 18 years of age live in your household. Please review your response and continue.]

[FORCED RESPONSE]

A8A.

How many children under 18 years of age live in your household?

[FORCED RESPONSE]

[NUMBOX; 0-99] Number of Children

[SHOW IF A8A > 0 AND A8A < 100]

[NUMBOX]

[PROMPT IF A8B > A8A: The number of your own children reported as living in your household is greater than the total number of children you said are living in your household. Please check your answers and change them so that the number of your own children is not bigger than the total number of children.]

[STANDARD PROMPT IF SKIPPED ON WEB]

A8B.

How many of these children are your own? Please include biological, adopted, and step children.

[NUMBOX; 0-99] Number of Your Children

COMPUTE DOV_HHSIZE:

DOV_HHSIZE = A8 + A8A

[SP]

A9.

Overall, how would you rate your health during the past four weeks?

RESPONSE OPTIONS:

Excellent
Very good
Good
Fair
Poor
Very poor

[SHOW IF DOV_HHSIZE > 1]

[SP]

A9A.

Overall, how would you rate the health of the family members in your household during the past four weeks?

RESPONSE OPTIONS:

Excellent
Very good
Good
Fair
Poor
Very poor

PN: WILL UPDATE LATER ONCE I HAVE A LIST OF PROGRAMS BY STATE FROM THE CLIENT

COMPUTE DOV_PROGRAM_NAME

IF A1 = 2 [AK], DOV_PROGRAM_NAME = 2 “DenaliCare”

IF A1 = 4 [AZ], DOV_PROGRAM_NAME = 4 “Arizona Health Care Cost Containment System (AHCCCS)”

IF A1 = 6 [CA], DOV_PROGRAM_NAME = 6 “Medi-Cal” “Medi-Cal”

IF A1 = 8 [CO], DOV_PROGRAM_NAME = 8 “Health First Colorado”

IF A1 = 9 [CT], DOV_PROGRAM_NAME = 9 “Husky Health”

IF A1 = 10 [DE], DOV_PROGRAM_NAME = 10 “Delaware Medical Assistance Program (DMAP)”

IF A1 = 11 [DC], DOV_PROGRAM_NAME = 11 “Healthy Families”

IF A1 = 13 [GA], DOV_PROGRAM_NAME = 13 “Georgia Medical Assistance”

IF A1 = 15 [HI], DOV_PROGRAM_NAME = 15 “Med-Quest”

IF A1 = 17 [IL], DOV_PROGRAM_NAME = 17 “Medical Assistance Program”

IF A1 = 19 [IA], DOV_PROGRAM_NAME = 19 “IA Health Link”

IF A1 = 20 [KS], DOV_PROGRAM_NAME = 20 “KanCare”

IF A1 = 22 [LA], DOV_PROGRAM_NAME = 22 “Healthy Louisiana”

IF A1 = 23 [ME], DOV_PROGRAM_NAME = 23 “MaineCare”

IF A1 = 25 [MA], DOV_PROGRAM_NAME = 25 “MassHealth”

IF A1 = 27 [MN], DOV_PROGRAM_NAME = 27 “Minnesota Medical Assistance”

IF A1 = 28 [MN], DOV_PROGRAM_NAME = 28 “MississippiCAN”

IF A1 = 29 [MO], DOV_PROGRAM_NAME = 29 “MO HealthNet”

IF A1 = 34 [NJ], DOV_PROGRAM_NAME = 34 “FamilyCare”

IF A1 = 35 [NM], DOV_PROGRAM_NAME = 35 “Centennial Care”

IF A1 = 40 [OK], DOV_PROGRAM_NAME = 40 “SoonerCare”

IF A1 = 41 [OR], DOV_PROGRAM_NAME = 41 “Oregon Health Plan”

IF A1 = 42 [PA], DOV_PROGRAM_NAME = 42 “Medical Assistance”

IF A1 = 44 [RI], DOV_PROGRAM_NAME = 44 “Rhode Island Medical Assistance”

IF A1 = 45 [SC], DOV_PROGRAM_NAME = 45 “Healthy Connections”

IF A1 = 47 [TN], DOV_PROGRAM_NAME = 47 “TennCare” “TennCare”

IF A1 = 50 [VT], DOV_PROGRAM_NAME = 50 “Green Mountain Care”

IF A1 = 53 [WA], DOV_PROGRAM_NAME = 53 “Apple Health”

IF A1 = 55 [WI], DOV_PROGRAM_NAME = 55 “ForwardHealth”

IF A1 = 56 [WY], DOV_PROGRAM_NAME = 56 “EqualityCare”

IF A1 = 2, 4, 6, 8, 9, 10, 11, 13, 15, 17, 19, 20, 22, 23, 25, 27, 28 29, 34, 35, 40, 41, 42, 44, 45, 47, 50, 53, 55, 56, DOV_A10INS = 1, ELSE DOV_A10INS = 0

[SP]

[PROMPT]

A10

There is a government program called Medicaid that pays for health care for persons in need. [SHOW IF DOV_A10INS = 1: In your state, you may also hear it called [DOV_PROGRAM NAME]. Are you [SHOW IF A8B > 0 AND A8B < 100: or any of your children] currently covered by Medicaid?

RESPONSE OPTIONS:

[SHOW IF A10 = 2]

[SP]

[PROMPT]

A10A.

Have you or anyone in your household ever received Medicaid benefits?

RESPONSE OPTIONS:

[SHOW IF A10=1 ]

[SP]

[PROMPT]

A10C.

Have your Medicaid benefits ever been reduced or ended because of your job or financial situation?

[SPACE]

RESPONSE OPTIONS:

[SP]

A11.

There is a program called SNAP that provides food purchasing assistance for persons in need. Did you receive any SNAP benefits last month? You may know this as Food Stamps. Please include only food stamps you received for you and your family.

[SPACE]

<unbold> Do not include food stamps received separately by other members of your household. <remove unbold>

RESPONSE OPTIONS:

[SHOW IF A11 = 2]

[SP]

A11A.

Have you or anyone in your household ever received SNAP benefits?

RESPONSE OPTIONS:

[SHOW IF A11=1 ]

[SP]

[PROMPT]

A11C.

Have your SNAP benefits ever been reduced or ended because of your job or financial situation?

[SPACE]

RESPONSE OPTIONS:

[SP]

A16.

There is a program called the Seniors Farmer’ Market Nutrition Program (SFMNP) that provides access to locally grown food assistance for older Americans in need. Did you receive any SFMNP benefits last month? Please include only SFMNP benefits you received for you and your family.

[SPACE]

<unbold> Do not include food stamps received separately by other members of your household. <remove unbold>

RESPONSE OPTIONS:

[SHOW IF A11 = 2]

[SP]

A16A.

Have you or anyone in your household ever received SFMNP benefits?

RESPONSE OPTIONS:

[SHOW IF A16=1 ]

[SP]

[PROMPT]

A16C.

Have your SFMNP benefits ever been reduced or ended because of your job or financial situation?

[SPACE]

RESPONSE OPTIONS:

COMPUTE DOV_A8B

IF A8B = 1, DOV_A8B = 1, child’s

IF A8B > 1, DOV_A8B = 2, children’s

COMPUTE DOV_CCDFPROG

CCDF Program

IF A1 = 1 [AL] FILL “Alabama Child CaRE ASSISTANCE”

IF A1 = 2 [AK] FILL “PASS PROGRAM”

IF A1 = 4 [AZ] FILL “Child Care Assistance Program”

IF A1 = 6 [CA] FILL “California Alternative Payment Programs”

IF A1 = 8 [CO] FILL “Colorado Child Care Assistance Program (CCCAP)”

IF A1 = 9 [CT] FILL “Care 4 Kids"

IF A1 = 10[DE] FILL “PURCHASE OF CARE”

IF A1 = 12 [FL] FILL “SCHOOL READINESS PROGRAM”

IF A1 = 13 [ga] FILL “Childcare and Parent Services (CAPS)”

IF A1 = 15 [HI] FILL “Child Care Connection Hawaii”

IF A1 = 16 [ID] FILL “Idaho Child Care Program (ICCP)”

IF A1 = 17 [IL} FILL “Child Care Assistance Program (CCAP)”

IF A1 = 18 [in] FILL “THE CCDF VOUCHER PROGRAM”

IF A1 = 19 [IA] FILL “CHILD CARE ASSISTANCE (CCA}”

IF A1 = 20 [ks] FILL “CHILD CARE SUBSIDY”

IF A1 = 21 [KY] FILL “child care assostance program for families”

IF A1 = 22 [LA] FILL “Child Care Assistance Program (CCAP)”

IF A1 = 23 [me] FILL “Child Care Subsidy Program (CCSP)”

IF A1 = 24 [MD] FILL “Child Care Scholarship Program”

IF A1 = 25 [ma] FILL “Early Education and Care Financial Assistance”

IF A1 = 26 [mi] FILL “Child Development and Care (CDC)”

IF A1 = 27 [Mn] FILL “basic sliding fee program”

IF A1 = 28 [ms] FILL “Child Care Payment Program”

IF A1 = 29 [mo] FILL “Child Care Subsidy Program”

IF A1 = 30 [mt] FILL “Best Beginnings Child Care Scholarship Program”

IF A1 = 31 [ne] FILL “Child Care Subsidy Program”

IF A1 = 32 [nv] FILL “CHILD CARE SUBSIDY PROGRAM”

IF A1 = 33 [nh] FILL “NH Child Care Scholarship”

IF A1 = 34 [nj] FILL “Child Care Assistance Program”

IF A1 = 35 [nm] [FILL “Child Care Assistance”

IF A1 = 36 [ny] FILL “child care subsidy program”

IF A1 = 37 [nc] FILL “Subsidized Child Care Assistance (SCCA) Program”

IF A1 = 38 [nd] FILL “child care assistance program”

IF A1 = 39 [oh] FILL “CHILD CARE VOUCHER PROGRAM"”

IF A1 = 40 [ok] FILL “child care subsidy”

IF A1 = 41 [or] FILL "Employment-Related Day Care (ERDC)”

IF A1 = 42 [pa] FILL “Child Care Works Subsidized Child Care”

IF A1 = 44 [ri] FILL “child care assistance program”

IF A1 = 45 [sc] FILL “SC Voucher Program”

IF A1 = 46 [sd] FILL “child care assistance program”

IF A1 = 47 [tn] FILL “Child Care Payment Assistance”

IF A1 = 48 [tx] FILL “Workforce Solutions Child Care”

IF A1 = 49 [ut] FILL “child care assistance”

IF A1 = 50 [vt] FILL “child care financial assistance”

IF A1 = 51 [va] FILL “child care assistance”

IF A1 = 53 [wa] FILL “Working Connections Child Care (WCCC)”

IF A1 = 54 [wv] FILL “child care services”

IF A1 = 55 [wi] FILL “Wisconsin Shares Child Care”

IF A1 = 56 [wy] FILL “Child Care Subsidy Program”

IF A1 = 1 [AL] FILL “Alabama Child Care Assistance”

IF A1 = 2 [AK] FILL “PASS Program”

IF A1 = 4 [AZ] FILL “Child Care Assistance Program”

IF A1 = 6 [CA] FILL “California Alternative Payment Programs”

IF A1 = 8 [CO] FILL “Colorado Child Care Assistance Program (CCCAP)”

IF A1 = 9 [CT] FILL “Care 4 Kids"

IF A1 = 10[DE] FILL “Purchase of Care”

IF A1 = 12 [FL] FILL “School Readiness Program”

IF A1 = 13 [ga] FILL “Childcare and Parent Services (CAPS)”

IF A1 = 15 [HI] FILL “Child Care Connection Hawaii”

IF A1 = 16 [ID] FILL “Idaho Child Care Program (ICCP)”

IF A1 = 17 [IL} FILL “Child Care Assistance Program (CCAP)”

IF A1 = 18 [in] FILL “The CCDF Voucher Program”

IF A1 = 19 [IA] FILL “Child Care Assistance (CCA}”

IF A1 = 20 [ks] FILL “Child Care Subsidy”

IF A1 = 21 [KY] FILL “Child Care Assistance Program for Families”

IF A1 = 22 [LA] FILL “Child Care Assistance Program (CCAP)”

IF A1 = 23 [me] FILL “Child Care Subsidy Program (CCSP)”

IF A1 = 24 [MD] FILL “Child Care Scholarship Program”

IF A1 = 25 [ma] FILL “Early Education and Care Financial Assistance”

IF A1 = 26 [mi] FILL “Child Development and Care (CDC)”

IF A1 = 27 [Mn] FILL “Basic Sliding Fee Program”

IF A1 = 28 [ms] FILL “Child Care Payment Program”

IF A1 = 29 [mo] FILL “Child Care Subsidy Program”

IF A1 = 30 [mt] FILL “Best Beginnings Child Care Scholarship Program”

IF A1 = 31 [ne] FILL “Child Care Subsidy Program”

IF A1 = 32 [nv] FILL “Child Care Subsidy Program”

IF A1 = 33 [nh] FILL “NH Child Care Scholarship”

IF A1 = 34 [nj] FILL “Child Care Assistance Program”

IF A1 = 35 [nm] [FILL “Child Care Assistance”

IF A1 = 36 [ny] FILL “Child Care subsidy program”

IF A1 = 37 [nc] FILL “Subsidized Child Care Assistance (SCCA) Program”

IF A1 = 38 [nd] FILL “Child Care assistance program”

IF A1 = 39 [oh] FILL “Child Care Voucher Program"”

IF A1 = 40 [ok] FILL “Child Care Subsidy”

IF A1 = 41 [or] FILL "Employment-Related Day Care (ERDC)”

IF A1 = 42 [pa] FILL “Child Care Works Subsidized Child Care”

IF A1 = 44 [ri] FILL “Child Care Assistance Program”

IF A1 = 45 [sc] FILL “SC Voucher Program”

IF A1 = 46 [sd] FILL “Child Care Assistance Program”

IF A1 = 47 [tn] FILL “Child Care Payment Assistance”

IF A1 = 48 [tx] FILL “Workforce Solutions Child Care”

IF A1 = 49 [ut] FILL “Child Care Assistance”

IF A1 = 50 [vt] FILL “Child Care Financial Assistance”

IF A1 = 51 [va] FILL “Child Care Assistance”

IF A1 = 53 [wa] FILL “Working Connections Child Care (WCCC)”

IF A1 = 54 [wv] FILL “Child Care Services”

IF A1 = 55 [wi] FILL “Wisconsin Shares Child Care”

IF A1 = 56 [wy] FILL “Child Care Subsidy Program”

[SHOW IF A8B>0 AND NOT SKIPPED ON WEB]

[SP]

A12.

As far as you know, do you receive any help from a state or federal child care subsidy or voucher program to pay for your [DOV_A8B] care? [SHOW IF A1 NOT = 3, 5, 7, 11, 14, 43, 52: In your state, you may also hear it called [DOV_CCDFPROG]].

RESPONSE OPTIONS:

[SHOW IF A12 = 2]

[SP]

A12A.

Have you or anyone in your household ever received help from a state or federal child care subsidy or voucher program?

RESPONSE OPTIONS:

[SHOW IF A12=1 ]

[SP]

[PROMPT]

A12C.

Have your child care benefits ever been reduced or ended because of a change in your job or financial situation?

[SPACE]

RESPONSE OPTIONS:

COMPUTE DOV_ELIGPROG

IF ALL A10, A10A, A10B, A11, A11A, A11B, A12, A12A, A12B = 0 or SKIPPED ON WEB, DOV_ELIGPROG = 0

IF A16 = 1 and AGE <60 DOV_ELIGPROG = 0

ELSE DOV_ELIGPROG = 1

IF DOV_ELIGPROG = 0, TERMINATE AND SEND TO TERMSORRY

[SHOW IF A10C = 1, A11C = 1, A16C = 1 or A12C=1 ]

[SP]

[PROMPT]

A17.

Earlier you said that you have had your benefits reduced due to a change in your job or financial circumstances. Did you later reapply for these benefits?

[SPACE]

	Reapplied	Did not reapply
[SHOW F A10C = 1] Medicaid	○ 1	○ 2
[SHOW F A11C = 1] SNAP	○ 1	○ 2
[SHOW F A16C = 1] SFMNP	○ 1	○ 2
[SHOW F A12C = 1] Subsidized child care/child care vouchers	○ 1	○ 2

RESPONSE OPTIONS:

[SP]

[PROMPT]

A13.

These next questions are about your personal goals and your current work-related activities.

[SPACE]

Are you currently working at a job or business for pay or profit?

[SPACE]

<unbold>Working includes being a student on paid work-study, self-employed and did not get paid that week, on vacation from work, traveling while employed, on personal leave, paid sick leave, or other temporary leave. <remove unbold>

RESPONSE OPTIONS:

[SHOW IF A13 = 2]

[SP]

[PROMPT]

A13A.

Have you been looking for paid work during the last four weeks?

RESPONSE OPTIONS:

[SHOW IF A13 = 2]

[SP]

A14.

Have you worked for pay at any time since January of 2020?

[SPACE]

<unbold>We are interested in both full-time and part-time work for pay or profit. <remove unbold>

RESPONSE OPTIONS:

COMPUTE DOV_FILERHH

If A4 = 1, DOV_FILERHH = A8B + 2

If A4 > 1, DOV_FILERHH = A8B + 1

[SHOW IF A13 = 1 OR A14 = 1]

[SP]

[PROMPT IF >14: You reported that your household income was [A15]. Please confirm that this is correct before continuing.]

[FORCE RESPONSE]

A15.

What was your total household income in 2021 before taxes or other deductions? Please include wages, salary, commissions, bonuses, or tips from all jobs, for all members of your household.

[SPACE]

<unbold>Your best guess is fine. <remove unbold>

RESPONSE OPTIONS:

Less than $5,000
$5,000 to $9,999
$10,000 to $14,999
$15,000 to $19,999
$20,000 to $24,999
$25,000 to $29,999
$30,000 to $34,999
$35,000 to $39,999
$40,000 to $49,999
$50,000 to $54,999
$55,000 to $59,999
$60,000 to $64,999
$65,000 to $74,999
$75,000 to $84,999
$85,000 to $99,999
$100,000 to $124,999
$125,000 to $149,999
$150,000 to $174,999
$175,000 to $199,999
$200,000 or more

COMPUTE DOV_ELIG_FPL

IF DOV_FILERHH = 1 AND A15 LE 6, DOV_ELIG_FPL = 1

IF DOV_FILERHH = 2 AND A15 LE 8, DOV_ELIG_FPL = 1

IF DOV_FILERHH = 3 AND A15 LE 9, DOV_ELIG_FPL = 1

IF DOV_FILERHH = 4 AND A15 LE 10, DOV_ELIG_FPL = 1

IF DOV_FILERHH = 5 AND A15 LE 12, DOV_ELIG_FPL = 1

IF DOV_FILERHH = 6 AND A15 LE 13, DOV_ELIG_FPL = 1

IF DOV_FILERHH = 7 AND A15 LE 14, DOV_ELIG_FPL = 1

IF DOV_FILERHH = 8 AND A15 LE 15, DOV_ELIG_FPL = 1

ELSE DOV_ELIG_FPL = 0

TERMINATE AND SEND TO TERMSORRY IF DOV_ELIG_FPL = 0

COMPUTE DOV_GENDER

IF A3 = 1, DOV_GENDER = 1, MALE “he” and “his” and “him”

IF A3 = 2, DOV_GENDER = 2, FEMALE “she” and “her”

IF A3= 3, 4 or 98, DOV_GENDER = 3, NOT MALE OR FEMALE “they” and “their”

COMPUTE DOV_AGE

IF A2 = 18 TO 29, DOV_AGE = “in [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] twenties”

IF A2 = 30 TO 39, DOV_AGE = “in [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] thirties”

IF A2 = 40 OR MORE, DOV_AGE “in [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] forties”

COMPUTE DOV_MARITAL

IF A4 LE 2 DOV_MARITAL = 1 “married”

IF A4 GE 3 DOV_MARITAL = 2 “unmarried”

PROGRAMMER: Construct three flags

Flag name	Benefit	Logic
A10_flag	Medicaid	IF A10 or A10a = 1, set A10_flag = 1
A11_flag	SNAP	IF A11 or A11a = 1, set A11_flag = 1
A12_flag	CCDF	IF A12 or A12a = 1, set A12_flag = 1

COMPUTE DOV_BENEFIT

If A12_flag = 1: Benefit = 1.

If A12_flag NE 1 AND A10_flag = 1 AND A11_flag = 1: Randomly assign Benefit 2, 3 or 4 (ACROSS DIFFERENT VIGNETTES AND RECORD BENEFIT SHOWN BY VIGNETTE. FOR EXAMPLE AN R WHO IS ASSIGNED VIGNETTES 2,4,3,5,6 MIGHT SEE BENEFIT 2 AT VIGNETTE 2, BENEFIT 4 AT VIGNETTE 4, ETC.)

If A12_flag NE 1 AND A10_flag = 1 AND A11_flag NE 1: Benefit = 3

If A12_flag NE 1 AND A10_flag NE 1 and A11_flag = 1: Benefit = 4.

ELSE—NONE OF ABOVE CONDITIONS ARE TRUE: Benefit = 0.

TERMINATE AND SEND TO TERMSORRY IF Benefit = 0

DOV_BENEFIT	DOV_BEN_NAME	Notes
1	child care subsidies
2	Medicaid and SNAP	For participants receiving both Medicaid and SNAP, randomly rotate the vignette scenarios to display either “SNAP,” “Medicaid,” or “Medicaid and SNAP.” Of the 5 fielded vignettes, ensure that two of the scenarios presented display “Medicaid and SNAP” and the other 3 scenarios randomly select either “SNAP” or “Medicaid.” Record the benefit scenario by person, by vignette, for analysis
3	Medicaid
4	SNAP

COMPUTE DOV_HOUSEHOLD_SIZE

COMPUTE DOV_HOUSEHOLD_SIZE = 1 .

If A4 LE 2 AND A8b = 0 AND DOV_BENEFIT = 1 HOUSEHOLD_SIZE = 3 (married, has children)

If A4 LE 2 AND A8b = 0 HOUSEHOLD_SIZE = 2 (married, no children)

If A4 GE 3 AND A8b GE 1 HOUSEHOLD_SIZE = 2 (unmarried, has children)

If A4 LE 2 AND A8b GE 1 HOUSEHOLD_SIZE = 3. (married, has children)

COMPUTE EARNINGS

COMPUTE THE VALUES FOR EARNINGS BASED ON DOV_HOUSEHOLD_SIZE

DOV_HOUSEHOLD_SIZE	DOV_EARNINGS
1	$1,300
2	$1,800
3	$2,300

For each vignette, randomly select a value for P_CONDITION from the following list and assign the corresponding values for DOV_RAISE, DOV_BEN_TOT, DOV_BEN_AMT and DOV_BEN_AMT2.

For example, if P_VIGNETTE = 6 and the randomly assigned order for the Vignettes to be shown to the R is 3,4,6,2,1:

Randomly assign any value of P_CONDITION _1: 15-17 to Vignette 3. If, for example, 15 is the value that is randomly assigned for P_CONDITION, assign DOV_RAISE=300, DOV_BEN_TOT=100, DOV_BEN_AMT=35 and DOV_BEN_AMT2=65 per the table below
For the next Vignette (Vignette 4), randomly assign any value between 15-17 to P_CONDITION_2. If, for example, 17 is the value that is randomly assigned for condition, assign DOV_RAISE=750, DOV_BEN_TOT=250, DOV_BEN_AMT=90 and DOV_BEN_AMT2=160 per the table below
Please repeat these steps for P_CONDITION, DOV_RAISE, DOV_BEN_TOT, DOV_BEN_AMT and DOV_BEN_AMT2 for the remaining vignettes.

P_CONDITION	DOV_RAISE	DOV_BEN_TOT	DOV_BEN_AMT1	DOV_BEN_AMT2
15	$300	$100	$35	$65
16	$650	$450	$160	$290
17	$750	$250	$90	$160

For each of the five fielded vignette, randomly select a name without replacement from the following list:

For example if P_NAME_1 is randomly assigned as 4, “Jamie” in the first vignette shown to the R, a different name should be randomly assigned in the next vignette. If P_NAME_2 is randomly assigned as 1, “Alex,” then the next name should be randomly assigned from 2,3,5,6 and not include any of the previously assigned names. Please do this for all five Vignettes

P_NAME

1 = Alex

2 = Angel

3 = Huan

4 = Jamie

5 = Jordan

6 = Sam

For each vignette, randomly select a treatment arm without replacement from the following list and assign the corresponding values for P_RISK and P_EASE.

For example, if P_VIGNETTE = 6 and the randomly assigned order for the Vignettes to be shown to the R is 3,4,6,2,1:

Randomly assign any value of TREATMENTARM_1: 1-6 to Vignette 3. If, for example, 5 is the value that is randomly assigned for treatment arm, assign P_RISK = 0 and P_EASE = 2 per the table below
For the next Vignette (Vignette 4), randomly assign any value between 1-6 EXCEPT 5 to TREATMENTARM_2. If, for example, 2 is the value that is randomly assigned for treatment arm, assign P_RISK = 1 and P_EASE = 0 per the table below
For the next Vignette (Vignette 6), randomly assign any value between 1-6 EXCEPT 5 or 2 to TREATMENTARM_3. If, for example, 1 is the value that is randomly assigned for treatment arm, assign P_RISK = 0 and P_EASE = 0 per the table below
Please repeat these steps for treatment arm, P_RISK and P_EASE for the remaining vignettes.

TREATMENT ARM

Treatment Arm	P_RISK	P_EASE
1	0	0
2	1	0
3	0	1
4	1	1
5	0	2
6	1	2

RANDOMIZE AND RECORD ORDER VIGNETTES ARE SHOWN IN

[SHOW IF P_VIGNETTE = 1,3,4,5,6]

[DISPLAY]

V1.

[P_NAME] is [DOV_AGE] and is [DOV_MARITAL]. [IF A8b GE 1 OR A12_flag = 1 DISPLAY: [P_NAME] also has a young child to take care of].

[P_NAME] works as a prep cook at a restaurant, where [IF DOV_GENDER = 1: he earns, IF DOV_GENDER = 2: she earns, IF DOV_GENDER = 3: they earn] about [DOV_EARNINGS] per month. [P_NAME] also receives [DOV_BEN_NAME] from the government. [IF DOV_GENDER = 1: He is, IF DOV_GENDER = 2: She is, IF DOV_GENDER = 3: They are] the only person earning money in their household.

Recently, [P_NAME] was offered a new job at another restaurant. The job has the same hours but pays more and would increase [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] income by [DOV_RAISE] per month.

[IF EASE = 0: Thankfully, this increase in income will not affect [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] [DOV_BEN_NAME] benefits. And, [P_NAME] could always go back to [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] old job if things didn’t work out.

IF P_EASE GE 1 and DOV_BENEFIT = 1: The higher income would cause [P_NAME] to lose [DOV_BEN_NAME], increasing their child care bill by [DOV_BEN_TOT] per month.

IF P_EASE GE 1 and DOV_BENEFIT = 2: The higher income would cause [P_NAME] to lose [DOV_BEN_NAME]. [IF DOV_GENDER = 1: He, IF DOV_GENDER = 2: She, IF DOV_GENDER = 3: They] would lose all [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] food stamps, which are worth [DOV_BEN_AMT1], and would have to purchase health insurance. [P_NAME] looked around and found a subsidized plan on healthcare.gov that costs [DOV_BEN_AMT2] per month and seems to provide about the same coverage as they already have, with the same copays and deductibles as Medicaid.

IF P_EASE GE 1 and DOV_BENEFIT = 3: The higher income would cause [P_NAME] to lose [DOV_BEN_NAME]. [IF DOV_GENDER = 1: He, IF DOV_GENDER = 2: She, IF DOV_GENDER = 3: They] would then have to purchase health insurance. [P_NAME] looked around and found a subsidized plan on healthcare.gov that costs [DOV_BEN_TOT] per month and seems to provide about the same coverage as they already have, with the same copays and deductibles as Medicaid.

IF P_EASE GE 1 and DOV_BENEFIT = 4: The higher income would cause [P_NAME] to lose all their food stamps, which is worth [DOV_BEN_TOT] per month.

IF P_EASE GE 1: [P_NAME] could always go back to [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] old job if things didn’t work out. If this happened, [P_NAME] would [IF P_EASE = 1: automatically get [DOV_BEN_NAME] back again thanks to a new policy in [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] state.] [IF P_EASE = 2: have to go through the reapplication process for [DOV_BEN_NAME] again, including filling out all the paperwork and waiting for approval.]

[P_NAME] is trying to decide whether to take the job. [IF P_RISK = 0: The restaurant has been around for a while and so it seems like a safe bet [IF P_RISK = 1: The restaurant is new and every time [P_NAME] has walked by it seemed pretty empty. If business doesn’t pick up the restaurant might not make it].

Below is a summary of how [P_NAME]’s situation might change if they take the new job.

Feature	Difference between old job and new job
Monthly income increase	[DOV_RAISE]
[IF P_EASE GE 1 DISPLAY ROW: Lost value of monthly [DOV_BEN_NAME] benefits]	[DOV_BEN_TOT]
Likelihood of losing the new job, and having to go back to [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] original, lower income	IF P_RISK = 0: Not likely IF P_RISK = 1: Likely
[IF P_EASE GE 1 DISPLAY ROW: Getting [DOV_BEN_NAME] back]	IF P_EASE = 1: Happens automatically IF P_EASE = 2: Requires re-application

INSERT TIMER V1_TIMER TO RECORD AMOUNT OF TIME R SPENDS ON PAGE

PN: PLEASE CREATE LOOPING LOGIC SUCH THAT THE QUESTIONS ARE SHOWN IN THE FOLLOWING ORDER:

EACH R SHOULD BE SHOWN 5 VIGNETTES AND THE ORDER SHOULD BE RANDOMIZED AND RECORDED

FIRST VIGNETTE SHOWN TO R (RANDOMLY ASSIGNED ONE OF 6 VIGNETTES)

DV1A (FIRST VIGNETTE SHOWN BELOW QUESTION)

DV1B (FIRST VIGNETTE SHOWN BELOW QUESTION)

DV1C (FIRST VIGNETTE SHOWN BELOW QUESTION)

DV2 (FIRST VIGNETTE SHOWN BELOW QUESTION)

DV3 (FIRST VIGNETTE SHOWN BELOW QUESTION)

DV4 (FIRST VIGNETTE SHOWN BELOW QUESTION)

DV5 (FIRST VIGNETTE SHOWN BELOW QUESTION)

DV6 (FIRST VIGNETTE SHOWN BELOW QUESTION)

SECOND VIGNETTE SHOWN TO R (RANDOMLY ASSIGNED ONE OF 6 VIGNETTES)

DV1C (SECOND VIGNETTE SHOWN BELOW QUESTION)

DV2 (SECOND VIGNETTE SHOWN BELOW QUESTION)

DV3 (SECOND VIGNETTE SHOWN BELOW QUESTION)

DV5 (SECOND VIGNETTE SHOWN BELOW QUESTION)

THIRD VIGNETTE SHOWN TO R (RANDOMLY ASSIGNED ONE OF 6 VIGNETTES)

DV1C (THIRD VIGNETTE SHOWN BELOW QUESTION)

DV2 (THIRD VIGNETTE SHOWN BELOW QUESTION)

DV3 (THIRD VIGNETTE SHOWN BELOW QUESTION)

DV5 (THIRD VIGNETTE SHOWN BELOW QUESTION)

PLEASE REPEAT THE SAME SEQUENCE SHOWN FOR SECOND AND THIRD VIGNETTE FOR THE FOURTH AND FIFTH VIGNETTE SHOWN TO R

[SHOW IF P_VIGNETTE = 1,2,4,5,6]

[DISPLAY]

V2.

[P_NAME] is [DOV_AGE] and is [DOV_MARITAL]. [IF A8b GE 1 OR A12_flag = 1 DISPLAY: [P_NAME] also has a young child to take care of].

[P_NAME] works at a landscaping company, where [IF DOV_GENDER = 1: he earns, IF DOV_GENDER = 2: she earns, IF DOV_GENDER = 3: they earn] about [DOV_EARNINGS] per month. [P_NAME] also receives [DOV_BEN_NAME] from the government. [IF DOV_GENDER = 1: He is, IF DOV_GENDER = 2: She is, IF DOV_GENDER = 3: They are] the only person earning money in their household.

Recently, [P_NAME] was offered a new job as a groundskeeper at a golf course. The job has the same hours but pays more and would increase [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] income by [DOV_RAISE] per month.

IF P_EASE = 0: Thankfully, this increase in income will not affect [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] [DOV_BEN_NAME] benefits. And, [P_NAME] could always go back to [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] old job if things didn’t work out.

IF P_EASE GE 1 and DOV_BENEFIT = 1: The higher income would cause [P_NAME] to lose [DOV_BEN_NAME], increasing their child care bill by [DOV_BEN_TOT] per month.

IF P_EASE GE 1 and DOV_BENEFIT = 4: The higher income would cause [P_NAME] to lose all their food stamps, which is worth [DOV_BEN_TOT] per month.

IF P_EASE GE 1: [P_NAME] could always go back to [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] old job if things didn’t work out. If this happened, [P_NAME] would [IF P_EASE = 1: automatically get [DOV_BEN_NAME] back again thanks to a new policy in to [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] state.] [IF P_EASE = 2: have to go through the reapplication process for [DOV_BEN_NAME] again, including filling out all the paperwork and waiting for approval.]

[P_NAME] is trying to decide whether to take the job. [IF RISK = 0: People who work there never seem to leave, and so the job seems pretty stable / IF RISK = 1: People who work there never seem to last long].

Below is a summary of how [P_NAME]’s situation might change if they take the new job.

Feature	Difference between old job and new job
Monthly income increase	[DOV_RAISE]
[IF P_EASE GE 1 DISPLAY ROW: Lost value of monthly [DOV_BEN_NAME] benefits]	[DOV_BEN_TOT]
Likelihood of losing the new job, and having to go back to his/her original, lower income	IF DOV_RISK = 0: Not likely IF DOV_RISK = 1: Likely
[IF P_EASE GE 1 DISPLAY ROW: Getting [DOV_BEN_NAME] back:]	IF P_EASE = 1: Happens automatically IF P_EASE = 2: Requires re-application

INSERT TIMER V2_TIMER TO RECORD AMOUNT OF TIME R SPENDS ON PAGE

[SHOW IF P_VIGNETTE = 1,2,3,5,6]

[DISPLAY]

V3.

[P_NAME] is [DOV_AGE] and is [DOV_MARITAL]. [IF A8b GE 1 OR A12_flag = 1 DISPLAY: [P_NAME] also has a young child to take care of].

[P_NAME] is a cashier at a store, where [IF DOV_GENDER = 1: he earns, IF DOV_GENDER = 2: she earns, IF DOV_GENDER = 3: they earn] about [DOV_EARNINGS] per month. [P_NAME] also receives [DOV_BEN_NAME] from the government. [IF DOV_GENDER = 1: He is, IF DOV_GENDER = 2: She is, IF DOV_GENDER = 3: They are] the only person earning money in their household.

Recently, a shift lead went on long-term leave. The store manager asked [P_NAME] if [IF DOV_GENDER = 1: he, IF DOV_GENDER = 2: she, IF DOV_GENDER = 3: they] wanted to replace her. [P_NAME] would work the same hours but being a shift lead comes with some additional responsibilities and would increase [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] income by [DOV_RAISE] per month.

IF P_EASE = 0: Thankfully, this increase in income will not affect [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] benefits. And, [P_NAME] could always go back to [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] old job if things didn’t work out.

IF P_EASE GE 1 and DOV_BENEFIT = 1: The higher income would cause [P_NAME] to lose [DOV_BEN_NAME], increasing their child care bill by [DOV_BEN_TOT] per month.

IF P_EASE GE 1 and DOV_BENEFIT = 4: The higher income would cause [P_NAME] to lose all their food stamps, which is worth [DOV_BEN_TOT] per month.

[P_NAME] is trying to decide whether to take the new position. [IF DOV_RISK = 0: The shift lead had been talking about quitting, and there is a good chance she won’t come back / IF DOV_RISK = 1: The shift lead said she would be back in a few months but maybe she won’t come back].

Below is a summary of how [P_NAME]’s situation might change if they take the new job.

Feature	Difference between old job and new job
Monthly income increase	[DOV_RAISE]
[IF P_EASE GE 1 DISPLAY ROW: Lost value of monthly [DOV_BEN_NAME] benefits]	[DOV_BEN_TOT]
Likelihood of losing the new job, and having to go back to his/her original, lower income	IF DOV_RISK = 0: Not likely IF DOV_RISK = 1: Likely
[IF P_EASE GE 1 DISPLAY ROW: Getting [DOV_BEN_NAME] back:]	IF P_EASE = 1: Happens automatically IF P_EASE = 2: Requires re-application

INSERT TIMER V3_TIMER TO RECORD AMOUNT OF TIME R SPENDS ON PAGE

[SHOW IF P_VIGNETTE = 1,2,3,4,6]

[DISPLAY]

V4.

[[P_NAME] is [DOV_AGE] and is [DOV_MARITAL]. [IF A8b GE 1 OR A12_flag = 1 DISPLAY: [P_NAME] also has a young child to take care of].

[P_NAME] works as a receptionist, where [IF DOV_GENDER = 1: he earns, IF DOV_GENDER = 2: she earns, IF DOV_GENDER = 3: they earn] about [DOV_EARNINGS] per month. [P_NAME] also receives [DOV_BEN_NAME] from the government. [IF DOV_GENDER = 1: He is, IF DOV_GENDER = 2: She is, IF DOV_GENDER = 3: They are] the only person earning money in their household.

Recently, [P_NAME]’s boss offered them a new position at the call center that pays more. [P_NAME] would work the same hours but would increase [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] income by [DOV_RAISE] per month.

IF P_EASE GE 1 and DOV_BENEFIT = 1: The higher income would cause [P_NAME] to lose [DOV_BEN_NAME], increasing their child care bill by [DOV_BEN_TOT] per month.

IF P_EASE GE 1 and DOV_BENEFIT = 4: The higher income would cause [P_NAME] to lose all their food stamps, which is worth [DOV_BEN_TOT] per month.

[P_NAME] is trying to decide whether to take the job. [IF DOV_RISK = 0: [P_NAME]’s friend works at the call center and said that she heard that they won some big new clients and a lot more work was coming / IF DOV_RISK = 1: [P_NAME]’s friend works at the call center and said that she heard that the company lost some big clients and that layoffs might be coming].

Below is a summary of how [P_NAME]’s situation might change if they take the new job.

Feature	Difference between old job and new job
Monthly income increase	[DOV_RAISE]
[IF P_EASE GE 1 DISPLAY ROW: Lost value of monthly [DOV_BEN_NAME] benefits]	[DOV_BEN_TOT]
Likelihood of losing the new job, and having to go back to his/her original, lower income	IF DOV_RISK = 0: Not likely IF DOV_RISK = 1: Likely
[IF P_EASE GE 1 DISPLAY ROW: Getting [DOV_BEN_NAME] back:]	IF P_EASE = 1: Happens automatically IF P_EASE = 2: Requires re-application

INSERT TIMER V4_TIMER TO RECORD AMOUNT OF TIME R SPENDS ON PAGE

[SHOW IF P_VIGNETTE = 1,2,3,4,5]

[DISPLAY]

V5.

[P_NAME] is [DOV_AGE] and is [DOV_MARITAL]. [IF A8b GE 1 OR A12_flag = 1 DISPLAY: [P_NAME] also has a young child to take care of].

[P_NAME] works as a janitor at a factory, where [IF DOV_GENDER = 1: he earns, IF DOV_GENDER = 2: she earns, IF DOV_GENDER = 3: they earn] about [DOV_EARNINGS] per month. [P_NAME] also receives [DOV_BEN_NAME] from the government. [IF DOV_GENDER = 1: He is, IF DOV_GENDER = 2: She is, IF DOV_GENDER = 3: They are] the only person earning money in their household.

Recently, [P_NAME]’s boss offered them a new position on the assembly line that pays more. [P_NAME] would work the same hours but would increase [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] income by [DOV_RAISE] per month.

IF P_EASE GE 1 and DOV_BENEFIT = 1: The higher income would cause [P_NAME] to lose [DOV_BEN_NAME], increasing their child care bill by [DOV_BEN_TOT] per month.

IF P_EASE GE 1 and DOV_BENEFIT = 4: The higher income would cause [P_NAME] to lose all their food stamps, which is worth [DOV_BEN_TOT] per month.

[P_NAME] is trying to decide whether to take the position. [IF DOV_RISK = 0: [P_NAME] has been at the factory for a while and thinks [IF DOV_GENDER = 1: he, IF DOV_GENDER = 2: she, IF DOV_GENDER = 3: they] would be good at it / IF DOV_RISK = 1: [P_NAME] has been at the factory for a while and knows that [IF DOV_GENDER = 1: he, IF DOV_GENDER = 2: she, IF DOV_GENDER = 3: they] won’t be able to stay on the line if [IF DOV_GENDER = 1: he, IF DOV_GENDER = 2: she, IF DOV_GENDER = 3: they] can’t make [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] numbers each day].

Below is a summary of how [P_NAME]’s situation might change if they take the new job.

Feature	New job
Monthly income increase	[DOV_RAISE]
[IF P_EASE GE 1 DISPLAY ROW: Lost value of monthly [DOV_BEN_NAME] benefits]	[DOV_BEN_TOT]
Likelihood of losing the new job, and having to go back to his/her original, lower income	IF DOV_RISK = 0: Not likely IF DOV_RISK = 1: Likely
[IF P_EASE GE 1 DISPLAY ROW: Getting [DOV_BEN_NAME] back:]	IF P_EASE = 1: Happens automatically IF P_EASE = 2: Requires re-application

INSERT TIMER V5_TIMER TO RECORD AMOUNT OF TIME R SPENDS ON PAGE

[SHOW IF P_VIGNETTE = 2,3,4,5,6]

[DISPLAY]

V6.

[P_NAME] is [DOV_AGE] and is [DOV_MARITAL]. [IF A8b GE 1 OR A12_flag = 1 DISPLAY: [P_NAME] also has a young child to take care of].

[P_NAME] works as a personal home aide, where [IF DOV_GENDER = 1: he earns, IF DOV_GENDER = 2: she earns, IF DOV_GENDER = 3: they earn] about [DOV_EARNINGS] per month. [P_NAME] also receives [DOV_BEN_NAME] from the government. [IF DOV_GENDER = 1: He is, IF DOV_GENDER = 2: She is, IF DOV_GENDER = 3: They are] the only person earning money in their household.

Recently, [P_NAME] was offered a job as an orderly in a nursing home. [P_NAME] would work the same hours but would increase [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] income by [DOV_RAISE] per month.

IF P_EASE GE 1 and DOV_BENEFIT = 1: The higher income would cause [P_NAME] to lose [DOV_BEN_NAME], increasing their child care bill by [DOV_BEN_TOT] per month.

IF P_EASE GE 1 and DOV_BENEFIT = 2: The higher income would cause [P_NAME] to lose [DOV_BEN_NAME]. ]. [IF DOV_GENDER = 1: He, IF DOV_GENDER = 2: She, IF DOV_GENDER = 3: They] would lose all [IF DOV_GENDER = 1: his, IF DOV_GENDER = 2: her, IF DOV_GENDER = 3: their] food stamps, which are worth [DOV_BEN_AMT1], and would have to purchase health insurance. [P_NAME] looked around and found a subsidized plan on healthcare.gov that costs [DOV_BEN_AMT2] per month and seems to provide about the same coverage as they already have, with the same copays and deductibles as Medicaid.

IF P_EASE GE 1 and DOV_BENEFIT = 4: The higher income would cause [P_NAME] to lose all their food stamps, which is worth [DOV_BEN_TOT] per month.

[P_NAME] is trying to decide whether to take the job. [IF DOV_RISK = 0: [IF DOV_GENDER = 1: He, IF DOV_GENDER = 2: She, IF DOV_GENDER = 3: They] heard about the job from someone in their building who heard that people who work there stay for a long time / IF DOV_RISK = 1: [IF DOV_GENDER = 1: He, IF DOV_GENDER = 2: She, IF DOV_GENDER = 3: They] heard about the job from someone in their building who heard that they are always hiring but that people who work there never seem to last].

Below is a summary of how [P_NAME]’s situation might change if they take the new job.

Feature	New job
Monthly income increase	[DOV_RAISE]
Lost value of monthly [DOV_BEN_NAME] benefits	[DOV_BEN_TOT]
Likelihood of losing the new job, and having to go back to his/her original, lower income	IF DOV_RISK = 0: Not likely IF DOV_RISK = 1: Likely
[IF P_EASE GE 1 Getting [DOV_BEN_NAME] back:]	IF P_EASE = 1: Happens automatically IF P_EASE = 2: Requires re-application

INSERT TIMER V6_TIMER TO RECORD AMOUNT OF TIME R SPENDS ON PAGE

Post-Vignette Questions

PN: For each vignette, display the vignette at the bottom of the screen while looping through the vignette follow-up questions above it. DV1a, DV1b, DV1c, DV4, and DV6 should only be displayed with the first vignette.

[NUMBOX]

[PROMPT IF DV1A NE DOV_RAISE This answer is incorrect, please read the description of [P_NAME]’s new job and try again.

DV1A.

How much more does the new job opportunity pay than [P_NAME]’s current job?

$[NUMBOX; 0-9999] per month

PN: SHOW FIRST VIGNETTE BELOW THIS QUESTION. ONLY SHOW WITH FIRST VIGNETTE

[NUMBOX]

[PROMPT IF P_EASE > 0 AND DV1B NE DOV_BEN_TOT This answer is incorrect, please read the description of [P_NAME]’s new job and try again.

[PROMPT IF P_EASE = 0 AND DV1B NE 0 This answer is incorrect, please read the description of [P_NAME]’s new job and try again. If the benefits will not decrease, please enter 0

DV1B.

If [P_NAME] takes the new job, by how much will their [DOV_BEN_NAME] benefits decrease?

$[NUMBOX; 0-9999] per month

○ 0 [P_NAME]’s benefits will not decrease

PN: SHOW FIRST VIGNETTE BELOW THIS QUESTION. ONLY SHOW WITH FIRST VIGNETTE

[SP]

DV1C.

If [P_NAME] has to go back to their old job, how would they go about getting their [DOV_BEN_NAME] benefits back?

RESPONSE OPTIONS:

[P_NAME] would get their [DOV_BEN_NAME] benefits back automatically
[P_NAME] would have to reapply for [DOV_BEN_NAME] benefits
[P_NAME] did not lose their [DOV_BEN_NAME] benefits

PN: SHOW FIRST VIGNETTE BELOW THIS QUESTION. ONLY SHOW WITH FIRST VIGNETTE

[SP]

[PROMPT]

DV2.

Do you think that [P_NAME] should take the new job?

RESPONSE OPTIONS:

[P_NAME] should take the new job
{P_NAME} should stay at their old job

PN: SHOW VIGNETTE BELOW THIS QUESTION. LOOP OF ALL VIGNETTES.

[SP]

DV3.

How certain are you that [P_NAME] [IF DV2 = 1 or 98: should, IF DV2 = 2: should not] take the new job?

RESPONSE OPTIONS:

Very uncertain
Uncertain
Somewhat uncertain
Somewhat certain
Certain
Very certain

PN: SHOW VIGNETTE BELOW THIS QUESTION. LOOP OF ALL VIGNETTES.

[MEDIUM TEXTBOX]

DV4.

Why do you think they [IF DV2 = 1 or 98: should, IF DV2 = 2: should not] take the new job?

[TEXTBOX]

PN: SHOW FIRST VIGNETTE BELOW THIS QUESTION. ONLY SHOW WITH LAST VIGNETTE.

[SP]

DV5.

If [P_NAME] has to go back to their old job, how easy or difficult do you think it is for [P_NAME] to get their benefits back?

RESPONSE OPTIONS

Very easy
Easy
Somewhat easy
Somewhat difficult
Difficult
Very difficult

PN: SHOW VIGNETTE BELOW THIS QUESTION. ONLY SHOW WITH LAST VIGNETTE.

[SHOW IF DV2 NOT SKIPPED ON WEB]

[SP]

DV6.

How stable does [P_NAME]’s new job sound?

RESPONSE OPTIONS:

Very unstable
Unstable
Somewhat unstable
Somewhat stable
Stable
Very stable

PN: SHOW FIRST VIGNETTE BELOW THIS QUESTION. ONLY SHOW WITH FIRST VIGNETTE

[MP]

B1.

Some people tell us they have made certain life decisions in order to keep their [DOV_BEN_NAME] benefits. In order to maintain my [DOV_BEN_NAME] benefits, I have:

[SPACE]

<unbold> Select all that apply <remove unbold>

RESPONSE OPTIONS:

Not taken a raise at my job
Not taken on additional hours at my job
Not taken a job offer
Not gotten married
Not accepted child support
Done something else to keep benefits
Have not made different life decisions in order to keep benefits [SP]

B2.

You said that you have done something else to keep your [DOV_BEN_NAME] benefits. What did you do?

[SPACE]

[TEXTBOX]

[SP]

C1.

It is vital to our study that we only analyze responses from people that paid close attention to this study. In your honest opinion, should we include your data in our analyses?

RESPONSE OPTIONS:

[TEXTBOX]

C2.

Before you exit the survey, is there anything else you want to tell us?

[MEDIUM TEXTBOX]

INSERT ITEM TIMESTAMPS: TIME_END, DATE_END

COMPUTE TEST_TIME

TEST_TIME = TIME_END – TIME_START

COMPUTE TEST_DATE = DATE_END

DISPLAY TESTING-ONLY SCREEN WITH VALUE FOR TEST_TIME & TEST_DATE

RE-COMPUTE QUAL=1 “COMPLETE”

SET CO_DATE, CO_TIME, CO_TIMER VALUES HERE

CREATE MODE_END

1=CATI

2=CAWI

SCRIPTING NOTES: PUT QFINAL1, QFINAL2, QFINAL3 in the same screen.

[SHOW IF PANEL_TYPE<20]

[SP]

QFINAL1. Thank you for your time today. To help us improve the experience of AmeriSpeak members like yourself, please give us feedback on this survey.

[RED TEXT – CAWI ONLY] If you do not have any feedback for us today, please click “Continue” through to the end of the survey so we can make sure your opinions are counted and for you to receive your AmeriPoints reward.

Please rate this survey overall from 1 to 7 where 1 is Poor and 7 is Excellent.

Poor						Excellent
1	2	3	4	5	6	7

[SHOW IF PANEL_TYPE<20 AND CAWI-ONLY]

[SP]

QFINAL2. Did you experience any technical issues in completing this survey?

Yes – please tell us more in the next question

[SHOW IF PANEL_TYPE<20]

[TEXTBOX]

QFINAL3. Do you have any general comments or feedback on this survey you would like to share? If you would like a response from us, please email [email protected] or call (888) 326-9424.

RE-COMPUTE QUAL=1 “COMPLETE”

SET CO_DATE, CO_TIME, CO_TIMER VALUES HERE

CREATE MODE_END

1=CATI

2=CAWI

[SHOW IF PANEL_TYPE<20]

[DISPLAY]

END.

Those are all the questions we have. We will add [INCENTWCOMMA] AmeriPoints to your AmeriPoints balance for completing the survey. If you have any questions at all for us, you can email us at [email protected] or call us toll-free at 888-326-9424. Thank you for participating in our new AmeriSpeak survey!

You can close your browser window now if you wish or click Continue below to be redirected to the AmeriSpeak member website.

[SHOW IF PANEL_TYPE>=20]

[DISPLAY]

CLOSEB.

Those are all the questions we have for you today. Please click “Continue” to submit your answers.

[BELOW REDIRECTS RETURN OFF-PANEL RESPONDENTS TO HOME PANEL]

Lucid redirects

Complete:
https://notch.insights.supply/cb?token=25e2fc81-f09c-4305-bbc4-97d1404fcbf5&RID=[insert_value]

Qualification Termination:
https://samplicio.us/s/ClientCallBack.aspx?RIS=20&RID=[insert_value]

Duplication/Security Termination:
https://samplicio.us/s/ClientCallBack.aspx?RIS=30&RID=[insert_value]

Overquota:
https://samplicio.us/s/ClientCallBack.aspx?RIS=40&RID=[insert_value]

Page 56

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Stephanie Jwo
File Modified	0000-00-00
File Created	2023-08-30